Project Summary ?Health literacy? (HL) refers to ?the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.? Among American Indians and Alaska Natives, 48% of adults have limited HL. This high rate of limitations is concerning given that restricted HL is related to poor health-related knowledge, attitudes, behaviors, and outcomes. Although it is clear that HL limitations among parents are related to suboptimal outcomes in children, few studies have examined the link between parental HL (PHL) and children's oral health. Further, because prior studies have used cross-sectional data, it is unclear whether PHL is related to change over time in children's oral health. The objective of the project is to investigate the association of PHL with change over time in pediatric oral health outcomes and to clarify the mechanisms that explain the PHL-outcomes relationship. The role of PHL will be explored in a sample of American Indians, a population at risk for poor oral health. Indeed, by age 5, 75% of Native children have dental decay. Using secondary data from the NIDCR-funded project ?Promoting Behavioral Change for Oral Health in American Indian Mothers and Children? (PBC; U54DE019259), the research team will use advanced analytic techniques to test a theoretical framework designed to clarify the mechanisms through which PHL is linked to pediatric oral health outcomes. The mediating roles of parental oral health knowledge, attitudes, and behavior will be examined. The PBC project is a randomized controlled trial designed to test the impact of a motivational interviewing intervention on parental oral health knowledge, attitudes, behavior, and pediatric oral health outcomes. The analysis sample will include 575 parent-child dyads recruited when the child was a newborn and followed for 3 years. The specific aims of the study are the following: (1) Using baseline data, assess the relationship of PHL with parental oral health knowledge, attitudes, and behavior; (2) Using longitudinal data, determine the relationship of baseline PHL with change over time in parental oral health knowledge, attitudes, and behavior, and with pediatric oral health outcomes; and (3) Determine whether the proposed theoretical framework accurately explains the relationships among baseline PHL; parental oral health knowledge, attitudes, and behavior; and pediatric oral health outcomes. The proposed project will be the first to examine the association of PHL with change over time in children's oral health outcomes and to clarify the mechanisms that explain that relationship. As testing of a comprehensive conceptual model of PHL has not been conducted, the study's results will advance science related to PHL and inform development of effective oral health interventions for American Indians and other high-risk populations. In addition, this work will provide a critical evaluation of the role PHL plays in the oral health of Native communities, a population at risk for limited PHL and poor pediatric oral health outcomes. The project addresses NIDCR's aims to overcome disparities in oral health and to examine risk factors and mechanisms of behavior change in oral health.